Hemorrhoids are cushions of tissue and varicose veins located in and around the rectal area. Hemorrhoids are very common, especially during pregnancy and after childbirth. It has been estimated that about half the population has hemorrhoids by age 50. They are caused by increased pressure in the veins of the anus. The most common cause is straining during bowel movements. Constipation, prolonged sitting during bowel movements, and anal infection may also contribute to the development of hemorrhoids. In some cases, hemorrhoids may be a manifestation of other diseases, such as liver cirrhosis.
Symptoms of hemorrhoids include rectal bleeding, particularly after bowel movements, pain during bowel movements, anal itching, mucus discharge, epithelial cell changes, thrombosis, incarcerations, skin tags, and disordered defecation. Symptoms may range from mild to severe.
In many cases, hemorrhoids are diagnosed by rectal examination. However, stool guaiac testing for the presence of occult blood, as well as sigmoidoscopy, anoscopy, and proctoscopy procedures may also be useful in establishing a diagnosis.
Treatment is generally based on the severity of symptoms. Mild cases may be controlled by conservative, non-invasive techniques such as drinking fluids, adhering to a high-fiber diet, use of stool softeners, and/or use of stool-bulking agents such as fiber supplements. In addition, treatments for symptomatic relief may include corticosteroid cream and/or warm baths to reduce pain and swelling.
For more severe cases involving severe pain and itching in patients who have not responded to conservative therapy, surgical intervention may be required to prevent more serious complications. For example, frequent or prolonged bleeding may result in iron deficiency anemia.
Conventional surgical techniques may be generally classified in three categories as being directed to either the anal sphincter, the hemorrhoidal tissue, or to the hemorrhoid feeding vessels. Surgical procedures directed to stretching or cutting of the internal anal sphincter include Lord's procedure, incisional sphincterotomy, and closed lateral anal sphincterotomy. However, these procedures may result in incontinence and thus are rarely indicated.
Surgical procedures directed to hemorrhoidal tissue include excisional hemorrhoidectomy and laser-assisted hemorrhoidectomy. Such procedures are relatively invasive and thus have a longer recovery period.
Surgical procedures directed to the feeder vessels include elastic or rubber band ligation, sclerosis, and photocoagulation. These procedures are associated with a variety of complications, including infection, hemorrhage, ulceration, oleogranuloma, allergic reaction, and prostate infection.
The need remains for minimally-invasive systems and methods for treating hemorrhoids.